Authorization & Insurance Specialist

RADIOLOGY ASSOCIATES OF TALLAHASSEE•Tallahassee, FL

17h•$18 - $21•Onsite

About The Position

With 65 years of service to the community as the premier imaging center in Tallahassee, we continue to grow and thrive. We are seeking superstars with a customer service mindset to join our team and share in our success.

Requirements

High school diploma or GED.
Minimum of three years of experience in healthcare insurance and/or prior authorizations.
Experience verifying insurance eligibility and benefits.
Knowledge of insurance verification processes and patient financial responsibility.
Knowledge of prior authorization workflows and payor requirements.
Basic understanding of CPT/ICD-10 concepts.
Knowledge of HIPAA and patient confidentiality.
Knowledge of workflow and time management in a healthcare setting.
Excellent organizational and time management abilities.
Attention to detail and accuracy.
Effective communication and interpersonal skills.
Skill in problem-solving and critical thinking.
Ability to manage multiple priorities in a fast-paced environment.
Proficiency in computer systems, including EMR/RIS platforms and Microsoft Office.
Ability to speak clearly and concisely.
Ability to read, understand, and follow oral, and written instruction.
Ability to sort and file materials correctly by alphabetic or numeric systems.
Ability to establish and maintain professional and effective working relationships with patients, employees, and the public.

Responsibilities

Verify patient insurance eligibility, benefits, and coverage requirements prior to date of service, ensuring accuracy and completeness
Review orders for completeness and obtain appropriate documentation to support authorization requests
Obtain prior authorizations for imaging services in a timely and accurate manner, maintaining consistency and attention to detail
Review and validate authorizations obtained by referring offices to ensure accuracy of patient demographics, insurance coverage, ordered exam, and authorization details; identify discrepancies and take appropriate action prior to the date of service
Monitor assigned work queues to ensure authorizations are obtained prior to the date of service whenever possible and escalate cases with missing or pending authorizations to avoid delays or reschedules
Prioritize time-sensitive exams and manage deadlines effectively in a fast-paced environment
Coordinate with referring offices to obtain clinical documentation, corrected orders, or additional information required for authorization and resolve discrepancies as needed
Investigate and resolve authorization-related issues, including denials, delays, or incomplete submissions, and follow through to resolution
Communicate authorization status updates to scheduling teams and other departments in a timely and consistent manner
Maintain accurate and up-to-date documentation within the system, ensuring data integrity and consistency
Ensure all processes comply with payer requirements, HIPAA regulations, and organization policies, maintaining confidentiality and professionalism in all interactions
Assist with coverage and workload distribution as needed to support team operations and maintain workflow continuity
Perform other duties as assigned